Global Health Practicum in the time of COVID-19

For most people, myself included, the pandemic upended our way of life, from the way we socialize to the way we work. Currently, I work as a pediatric surgeon, so prior to starting my MPH, I figured that I would have to find a practicum experience that would be flexible with regard to my work schedule; allowing me to meet my clinical responsibilities while fulfilling my practicum requirement. More importantly, I wanted an experience that would allow me to marry my research interest in access to prenatal care and neonatal outcomes in sub-Saharan Africa. For all these reasons, I was extremely excited when I got the opportunity to work with the UNC Gillings Zambia group which focuses on “improving public health, locally and globally.” Specifically, I was selected as a practicum intern for the Antenatal Care/ Postnatal Care Research Collective – Household Survey (ARCH), a multinational collaborative that aims to optimize birth outcomes in low resource settings. I don’t think that I could have asked for a better practicum opportunity, as it aligned perfectly with my interests.

In my role, I will be working to help with study start-up and implementation of a new longitudinal household survey of 5,000 households in Lusaka, Zambia. The goal of this survey is to gain a better understanding of the behavioral and reproductive health of women of reproductive age. Ultimately, the results from the study will provide estimates of the burden of maternal, newborn, and infant disease; and provide information regarding key risk factors and social disadvantages that contribute to adverse maternal and neonatal outcomes. I am excited to be part of this study, albeit in a small way, because I think we know little about factors related to preconception and antenatal care of women in resource-limited areas. This area of research is particularly important because I think better understanding will provide information not only regarding factors affecting maternal health, but also regarding the burden of birth defects and help to inform planning for and improving neonatal outcomes.

During my practicum experience, I will be working to develop training materials for field research staff and recruitment materials for study participants.  Over the last few weeks, I have been working on getting acquainted with the study protocol, and meeting key personnel for the study. I have also started working on some of the participant recruitment materials.  It has been really interesting having meetings on Zoom to discuss the study and its initiation. It has made me long more for in-person meetings, because I think that it would have been great to meet some of the people with whom I’d be working. I also think that it would have been an amazing opportunity to be on ground in Lusaka. I am still hoping that I will be able to visit the Zambia Hub in the future.  In spite of the challenges regarding not being in-person, I have been fortunate to have a preceptor who has been available and easily accessible.

There are number of things that I am looking forward to in my practicum. Firstly. I am looking forward to learning how to carry a research study from a concept, to one that is actualized in practice. I am also looking forward to developing the training schedule and materials that will be instrumental in initiating the study. I feel that this project will allow me to think critically about an important part of research study implementation, in which I have little experience. Lastly, I hope that this experience will provide opportunities to build relationships with researchers who have similar interests, in improving prenatal access to care and neonatal outcomes, in resource-limited settings.  As a physician who is interested in global surgery and research, my involvement will therefore provide me with the skills to develop study management tools, train research staff in international settings, and establish methods to monitor data quality. Given that the study is still in the early stages of implementation and initiation, I believe that I will gain valuable experience regarding the successful implementation of a research protocol.

Although I expect to have a busy summer, I’m planning on making the most of the sunny days by doing as much work as I can outside :).

‘Desola

Practicing gratitude in times of uncertainty

A lookout from a mountain and looking into the forest.
Taking in some views.

As most others can relate, it is disappointing to have an online program after a year of online coursework. However, this last year I have become well-acquainted with practicing gratitude in times of disappointment or uncertainty. I have found many things to be grateful for. First, I am grateful to be learning from and working alongside with many committed individuals through the UNC Division of Global Women’s Health. This is one of the Zambia Hub internships that focuses on program management and administration. Additionally, the flexibility of a remote practicum has allowed me to visit family and friends that I otherwise would not be able to! The flexibility has made it possible to pursue other interests as well without feeling like I am neglecting the valuable internship experience.

There are two projects I will be working on this summer, one for cervical cancer in low-resource settings and the other to address adverse birth outcomes. My responsibility is to design a suite of communication materials to indicate on a larger level how UNC is contributing to the body of research and clinical practice in novel and innovative ways. This has consisted of an orientation period in which I reviewed program quarterly and annual reports, proposals, and the literature from the researchers and others.  I have worked with my preceptor, the program manager, to interview the country leads to understand their need for communication materials as well as central themes and gaps in the research or practice. The website content I drafted will be up on the website somewhat soon!

Flowers looking out into the vast forest.
Nature.
Lighthouse from a grassy area.
Lighthouse.

Overall, I am excited to gain some valuable insight into how a multi-level research program operates and how one manages several different projects at once. One of my favorite things I am learning is how important it is to keep perspective in how individual programs contribute to the overall goals of an organization. That being said, I know I have a lot to learn and look forward to that over the next several weeks!

Due to the remote format, I have been in the Triangle area rather than in Zambia. But I am happy to be able to explore some more of the beautiful state of North Carolina.

–       Renée

Zooming to Zambia

Out in nature
Out in nature

With the school not approving Summer travels, I knew it was highly improbable for me to travel to Lusaka, Zambia, for my practicum. Nevertheless, I had the tiniest hope that things would work out just in time to make the journey possible. I felt like I deserved the trip after a semester-long love-hate affair with virtual meetings and zoom (zoom fatigue). Somehow, my “tiniest hope” yielded nothing, as I am still here in the triangle, collaborating with the research team in Zambia via zoom. I call it Zooming to Zambia!

To cope with the disappointment, I decided to make a mental visit to Zambia. In my mind, I arrived in Lusaka (Zambia) on May 17, 2021, to commence my practicum, and since then, I wake up each day saying Zikomo kwambiri, a phrase in Zambia that means “thank you very much.” I say this phrase for a couple of reasons. First, it helps me stay focused on my practicum work. Waking up to this phrase gives me a mindset of rolling up my sleeves and working on my daily goals. Second, to express my gratitude for the opportunity to work on a project I am passionate about. I did not come about this latter reason arbitrarily. Having a heart of gratitude has defined my existence over the past year, and it has seen me through the endless days of zoom fatigue and feelings of isolation.

Taking in the scenery
Taking in the scenery

My practicum is qualitative research to assess the feasibility and acceptability of engaging family members to support HIV-positive mothers to practice recommended infant care and feeding practices, and adherence to antiretroviral therapy. We are using a formative research technique- the Trial of Improved Practices (TIPs) for this study. So far, the work has been gratifying and deeply rewarding. On weekdays, I have a regular work schedule. In addition, I have virtual meetings with my preceptor, Dr. Stephanie Martin, to assess the progress of the study, and I also meet with the research team to review the data and troubleshoot the various challenges and hurdles experienced by the data collectors. Through the research, I look forward to gaining a thorough understanding of the role of partners and other support systems in the prevention of mother-to-child transmission of HIV.

To rejuvenate and recharge, I ensure my Saturdays are work-free. I use this time off to hike with international friends and pursue other interests. I recently took a hike at the Raven Rock State Park (see the goofy pictures). Upcoming hikes will be all-day hikes at the Hanging Rock and Appalachian Trail.

For now, even though I am stuck with zoom and virtual meetings, I could not have asked for a better practicum, preceptor, and research team. So I am grateful for the opportunity, and the tech that make virtual collaborations possible. For these reasons, I say Zikomo Kwambiri.

Olu Adeniran

Zikomo Kwambiri is from the Nyanja language, which is spoken widely in Lusaka.